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70 巻, 10 号
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腸管内のM. chelonae の存在と汚染との関係およびM. chelonae 胆管胆嚢感染症の1例下出 久雄, 安斉 栄子, 村田 嘉彦, 草島 健二, 市原 宏, 高野 智子, 平山 典保, 佐藤 信英, 小林 義隆1995 年 70 巻 10 号 p. 571-577
発行日: 1995/10/15
公開日: 2011/05/24
ジャーナル フリーIn 1993, thirteen strains (8.7%) of M. chelonae were isolated from bronchoalveolar lavage fluid (BALF) obtained by bronchoscopy of 150 patients in Tachikawa-sogo (T) hospital, where the same automated disinfection machine was commonly used for cleaning sterilization and disinfection of fiberbronchoscope and fibercolonoscope except 3 broncho scopes disinfected by gas sterilization.
Since January 1994, manual cleaning and sterilization has been applied for broncho scope, and thereafter no strain of M. chelonae was isolated from BALF of 55 patients in the T hospital.
While only one strain (3%) of M. chelonae was isolated from BALF of 33 patients in Ota (O) hospital, but many strains of M. chelonae were isolated from intestinal fluid obtained by fibercolonoscopy of the patients. Manual method of cleaning and disinfection was perfomed for both bronchoscopes and colonoscopes in the O hospital from the beginning.
Based on these rusults, it was suggested that M. chelonae are commonly present in the colon (intestine) of normal persons. Thus colonoendscope may be often contaminated with the organism and subsequently the automated disinfecting machine may also be conta minated with the organism whic which is resist and against usual disinfection procedure, and resulted in bronchoscope contamination.
If the presence of M. chelonae in intestinal tract is not rare, bile duct may be naturally infected with the organism. A case of cholecystitis and cholangitis caused by M. chelonae, which has not been reported previously, was found in the T hospital.抄録全体を表示PDF形式でダウンロード (795K) -
山口 靖明, 鈴木 茂毅1995 年 70 巻 10 号 p. 579-584
発行日: 1995/10/15
公開日: 2011/05/24
ジャーナル フリーA Tuberculosis epidemic occured in a hospital in Fukushima prefecture, 1993. It was detected after the diagnosis of two tuberculosis cases among nurses working in the hospital.
A contact survey in the hospital revealed two another cases of tuberculosis, one from the nurse, and the other one from the patient admitted to the hospital. In addition, two more nurses in the same hospital were suspected of having tuberculosis, but they do not yet started treatment by the time of the survey.
Though the source of the infection could not be identified, the doctor's delay in detecting cases was suspected on the background of the epidemic. Deficiency in the health care system of nursing school was also suspected.抄録全体を表示PDF形式でダウンロード (886K) -
国療化研第33次A調査報告佐藤 紘二, 永井 英明, 倉島 篤行, 毛利 昌史, 片山 透1995 年 70 巻 10 号 p. 585-589
発行日: 1995/10/15
公開日: 2011/05/24
ジャーナル フリーWe studied 266 patients with drug-resistant pulmonary tuberculosis at national sanatoria in Japan. The patients included 218 men (mean age, 58 years) and 48 women (mean age, 62 years). The levels of isoniazid and rifampicin resistance were determined at 1 mcg/mL and 50 mcg/mL, respectively. The results were as follows. (1) Most patients with drug-resistant pulmonary tuberculosis were middle-aged or past middle-aged. (2) There were many cases of drug-resistant pulmonary tuberculosis in previously treated tuber culosis patients with active disease and several cases in previously untreated pulmonary tuberculosis patients. However, in some previously untreated patients active tuberculosis was convert relatively easily to inactive tuberculosis. (3) Concerning life style, bachelors who drank heavily were more likely to develop drug-resistant pulmonary tuberculosis. (4) Most cases of drug-resistant pulmonary tuberculosis had at least one cavity on chest radiographs. (5) Several patients with drug-resistant tuberculosis left the hospital against the advice of their attending doctors; therefore, it was difficult to treat their illnesses. (6) In more than half the cases in which Mycobacterium tuberculosis was resistant to isoniazid and rifampicin, tolerance to streptomycin and ethanbutol was also seen. (7) When patients with drug-resistant pulmonary tuberculosis continued to have tuberculous bacilli in their sputum after 3 months of chemotherapy, there was a tendency for them to expectorate tuberculous bacilli in their sputum. For these drug-resistant tuberculosis patients, we must pay attention not only to the medical aspects but also to the social aspects of their disease.抄録全体を表示PDF形式でダウンロード (591K) -
菊地 和博, 石井 芳樹, 菅間 康夫, 北村 諭1995 年 70 巻 10 号 p. 591-594
発行日: 1995/10/15
公開日: 2011/05/24
ジャーナル フリーThe patient was 38-year-old male. His chief complaint was persistent cough. He had been diagnosed at an another clinic as tuberculosis by positive sputum culture. Laboratory findings at the first examination were as follows: ESR was 10mm/1 hr and CRP was 0.920 mg/dl and other data were within normal limits. Chest X-ray showed infiltrative shadow in the left lower lobe. Bronchoscopic findings before treatment were as follows: there were ulcers on bilateral vocal cords, small white nodules with reddness in trachea and red nodules and white coated ulcers in left main bronchus. He was treated with combination chemotherapy (INH, RFP, EB) and the steroid inhalation was added 1 month later after the initiation of chemotherapy. Bronchoscopic findings at 2 months after starting chemotherapy were as follows: lesions of vocal cords and trachea were improved and lesion of left main bronchus was scarred without stenosis.
Bronchial stenosis as sequelae of endobronchial tuberculosis deteriorates the patients' quality of life. Therefore it is important to diagnose endobronchial tuberculosis early and to start treat with chemotherapy as soon as possible, and the follow up by bronchoscopy should be done during treatment.抄録全体を表示PDF形式でダウンロード (5780K) -
下方 薫1995 年 70 巻 10 号 p. 595-600
発行日: 1995/10/15
公開日: 2011/05/24
ジャーナル フリーTuberculous pleurisy is restricted to the pleural cavity and profuse pleural fluid, which contains numerous immunocompetent cells, is easily obtained. Therefore, tuberculous pleurisy is a good model for the study of local cellular immunity.抄録全体を表示PDF形式でダウンロード (721K) -
古賀 宏延1995 年 70 巻 10 号 p. 601-606
発行日: 1995/10/15
公開日: 2011/05/24
ジャーナル フリーThe application of molecular biology techniques to the diagnosis of mycobacteriosis was evaluated. The hybridization protection assay (HPA) was found to be accurate and rapid in the identification of mycobacteria. The nested polymerase chain reaction (PCR) targeting the Pab gene was specific and sensitive enough for the rapid detection of Mycobacterium tuberculosis in clinical specimens. The overall sensitivity and specificity of the nested PCR were excellent, 97% and 92%, respectively. In addition, a novel method combining the PCR and the HPA for the rapid detection of MAC and M. tuberculosis was developed. This method was as useful as the nested PCR for M. tuberculosis above mentioned. The clinical usefulness of two commercially available mycobacteria detection kits, the MTD and the Amplicor, was evaluated and compared with that of the conventional smear and culture methods. The MTD showed the highest sensitivity, while the Amplicor showed the highest specificity. The HPA was also applied to drug susceptibility tests, which require 3 to 4 weeks by conventional methods. By this method, the results of resistance to isoniazid or rifampicin could be obtained after three days incubation. Another method for determining the drug resistance of mycobacteria is the detection of genealterations related to the drug resistance. The deletion of the catalase-peroxidase gene related to isoniazid resistance was observed in 15% of isoniazid-resistant strains. On the other hand, point mutations in the RNA polymerase β subunit (rpoB) gene relating to rifampicin resistance were detected in 31% of rifampicin-resistant strains by the nonradioisotope PCR-SSCP analysis. In contrast, the PCR-direct sequencing analysis of a 69bp fragment in the rpoB gene of M. tuberculosis was useful in predicting rifampicin-resistant phenotypes. The application of molecular biology techniques may be a useful strategy for the diagnosis of mycobacteriosis in future.抄録全体を表示PDF形式でダウンロード (738K) -
1995 年 70 巻 10 号 p. 611-613
発行日: 1995/10/15
公開日: 2011/05/24
ジャーナル フリーPDF形式でダウンロード (369K)
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